EP3498196B1 - Wiederverwendbarer chirurgischer klammerapplikator mit mehrfachauslösung - Google Patents
Wiederverwendbarer chirurgischer klammerapplikator mit mehrfachauslösung Download PDFInfo
- Publication number
- EP3498196B1 EP3498196B1 EP18212054.3A EP18212054A EP3498196B1 EP 3498196 B1 EP3498196 B1 EP 3498196B1 EP 18212054 A EP18212054 A EP 18212054A EP 3498196 B1 EP3498196 B1 EP 3498196B1
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- EP
- European Patent Office
- Prior art keywords
- assembly
- proximal
- handle
- distal
- pair
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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Images
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
- A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/30—Surgical robots
- A61B34/35—Surgical robots for telesurgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0023—Surgical instruments, devices or methods, e.g. tourniquets disposable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00477—Coupling
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0803—Counting the number of times an instrument is used
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0813—Accessories designed for easy sterilising, i.e. re-usable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0814—Preventing re-use
Definitions
- the present disclosure relates to surgical clip appliers and, more particularly, to a reposable multi-fire surgical clip applier including a handle assembly, a shaft assembly, and a clip cartridge assembly that are configured for selective disassembly to facilitate disposal of any disposable component(s) and reprocessing of any reusable component(s) for further use.
- Clip appliers that are able to apply multiple clips during a single entry into a body cavity, for example, are described in commonly-assigned U.S. Pat. Nos. 5,084,057 and 5,100,420 to Green et al.
- Another multiple clip applier is disclosed in commonly-assigned U.S. Pat. No. 5,607,436 by Pratt et al. - U.S. Pat. No. 5,695,502 to Pier et al. discloses a resterilizable surgical clip applier that is configured to receive and cooperate with an interchangeable clip magazine so as to advance and form multiple clips during a single entry into a body cavity.
- US 2017/238936 A1 discloses a clip cartridge assembly for use with a reposable surgical clip applier including a clip tray, a plurality of surgical clips, and a cover.
- the clip tray includes a plurality of distally oriented, deflectable, resilient fingers projecting from a base wall thereof. Each resilient finger terminates in a distal shoulder and a proximal end of the clip tray is configured for selective connection with a clip pusher bar of an endoscopic assembly of the reposable surgical clip applier.
- the cover includes a plurality of distally oriented, deflectable, resilient fingers projecting within a channel defined through proximal and distal ends thereof. Each resilient finger of the cover terminates in a distal shoulder and the cover includes a pair of opposed slots defined within sidewalls of the channel configured to slidably retain the clip tray and the plurality of surgical clips therein.
- a reposable surgical clip applier is also provided.
- US 4,226,242 discloses a cartridge for use with a repeating hemostatic clip applying instrument.
- the instrument is generally shaped and operated in the manner of prior clip applying instruments. Shaped like a pair of dog-nosed pliers, the outer ends of the jaws are adapted to hold a clip which may be applied to a blood vessel with the instrument. The rearward portion of the jaws overlap and a rectangular channel is formed in one of them through which clips may be pushed by a pusher extending down the center line of the instrument.
- One of the jaws is adapted to receive a cartridge containing a stack of U-shaped clips which may be pushed one at a time to the distal end of the jaws by the pusher.
- the cartridge is provided with a spring for urging the U-shaped stack of clips down to the pusher channel, and a clip follower for preventing misalignment of the clips in the cartridge.
- the present disclosure relates to a reposable multi-fire surgical clip applier including a handle assembly, a shaft assembly, and a clip cartridge assembly that are configured for selective disassembly to facilitate disposal of any disposable component(s) and reprocessing of any reusable component(s) for further use.
- a reposable surgical clip applier provided in accordance with aspects of the present disclosure includes a handle assembly, a shaft assembly releasably engagable with the handle assembly, and a clip cartridge assembly releasably engagable within the shaft assembly.
- the handle assembly includes a housing, at least one handle movable relative to the housing between a spaced-apart position and an approximated position, and an inner actuation assembly extending from the housing.
- the inner actuation assembly includes a proximal drive member movable through the housing, a proximal pusher bar movable through the proximal drive member, and a handle spring assembly.
- the handle spring assembly includes at least one spring arm engaging the at least one handle to bias the at least one handle towards the spaced apart position. Movement of the at least one handle relative to the housing is configured to move the proximal drive member and the proximal pusher bar in relative opposing directions.
- the shaft assembly includes an outer tube, a jaw assembly supported at a distal end portion of the outer tube, and an inner drive slidably disposed within the outer tube and operably coupled to the jaw assembly such that distal movement of the inner drive through the outer tube actuates the jaw assembly.
- the clip cartridge assembly retains a stack of surgical clips therein and includes a distal pusher operably coupled to a distal-most surgical clip of the stack of surgical clips such that distal movement of the distal pusher loads the distal-most surgical clip into the jaw assembly when the clip cartridge assembly is releasably engaged within the shaft assembly.
- the proximal drive member is positioned proximally adjacent the inner drive assembly such that movement of the at least one handle towards the approximated position actuates the jaw assembly
- the proximal pusher bar is positioned proximally adjacent the distal pusher such that movement of the at least one handle towards the spaced-apart position loads the distal-most surgical clip into the jaw assembly.
- the handle spring assembly includes a transverse body portion releasably retained within a proximal end portion of the housing.
- the transverse body portion defines a bore configured to be in communication with the outer tube of the shaft assembly such that, the proximal drive member is movable through the bore of the handle spring assembly to engage the inner drive assembly of the shaft assembly upon movement of the at least one handle.
- the at least one spring arm of the handle spring assembly extends outwardly from the transverse body portion and includes a free proximal end portion.
- the free proximal end portion of the at least one spring arm is slidable along the at least handle upon movement of the at least one handle.
- the housing includes at least one internal feature defining a pivot recess configured to movably receive a distal end portion of the at least one handle.
- the pivot recess and the at least one handle are sized and configured to cooperate to limit movement of the at least one handle beyond a predetermined approximated position and beyond a predetermined spaced-apart position.
- movement of the at least one handle towards the approximated position moves the proximal drive member distally about the proximal pusher bar and moves the proximal pusher bar proximally about and through the proximal drive member.
- movement of the at least one handle towards the spaced-apart position moves the proximal drive member proximally about the proximal pusher bar and moves the proximal pusher bar distally about and through the proximal drive member.
- the clip cartridge assembly further includes a biasing member configured to bias the distal pusher proximally.
- the clip cartridge assembly further includes a cartridge housing having a support base configured to support at least a portion of the distal pusher.
- the support base includes a distal bridge portion and a proximal bridge portion.
- the biasing member of the cartridge assembly is operably coupled to the distal pusher and to the proximal bridge portion to bias the distal pusher proximally.
- the clip cartridge assembly further includes a clip carrier including a pair of engagement flanges.
- the cartridge housing includes a pair of internal grooves extending longitudinally along at least a portion of a length of the cartridge housing.
- the pair of internal grooves may be configured to laterally receive the pair of engagement flanges, respectively, to inhibit axial movement of the clip carrier relative to the cartridge housing.
- the clip cartridge assembly further includes a carrier lock disposed proximally adjacent a proximal end portion of the clip carrier.
- the carrier lock includes a pair of opposing arms configured to biasingly engage a pair of opposing internal walls of the cartridge housing, wherein the carrier lock is configured to inhibit proximal movement of the clip carrier relative to the cartridge housing beyond the carrier lock.
- the housing of the handle assembly includes an open distal end portion defining a central passageway and a protrusion extending inwardly into the central passageway.
- the shaft assembly includes a tubular proximal segment defining a slot configured to receive the protrusion upon insertion of the tubular proximal segment into the open distal end portion to releasably engage the shaft assembly with the handle assembly.
- the shaft assembly further includes an inner bushing disposed between the tubular proximal segment and the inner drive assembly.
- the inner bushing has a slot configured to be axially aligned with the slot of the tubular proximal segment when the inner bushing is disposed therein.
- the protrusion extending inwardly from the housing is received within the slot of the tubular proximal segment and the slot of the inner bushing.
- the handle assembly includes a pair of handles pivotably coupled to the housing and extending from opposed sides thereof.
- the handle spring assembly includes a transverse body portion releasably retained within a proximal end portion of the housing and a pair of spring arms extending outwardly from opposing sides of the transverse body portion.
- each spring arm of the pair of spring arms are configured to engage a respective handle of the pair of handles to bias the pair of handles towards the spaced-apart position.
- the pair of spring arms each includes a free proximal end portion configured to slide along the respective handle of the pair of handles upon movement of the pair of handles.
- the handle assembly further includes a linkage assembly configured to pivotably couple the pair of handles to the inner actuation assembly.
- the linkage assembly includes a first link arm configured to operably couple a first handle of the pair of handles to the proximal drive member and a second link arm configured to operably couple a second handle of the pair of handles to the proximal pusher bar.
- the first link arm upon movement of the pair of handles towards the approximated position, the first link arm is configured to move the proximal drive member distally and the second link arm is configured to move the proximal pusher bar proximally.
- the first link arm upon movement of the pair of handles towards the spaced-apart position, the first link arm is configured to move the proximal drive member proximally and the second link arm is configured to move the proximal pusher bar distally.
- the linkage assembly is configured to move the proximal drive member concurrently with the proximal pusher bar upon movement of the pair of handles.
- linkage assembly further includes a third link arm configured to operably couple the second handle of the pair of handles to the proximal drive member and a fourth link arm configured to operably couple the first handle of the pair of handles to the proximal pusher bar.
- the proximal pusher bar is configured to move between the first link arm and the third link arm as the proximal pusher bar moves through the proximal drive member.
- a reposable surgical clip applier provided in accordance with another aspect of the present disclosure includes a handle assembly.
- the handle assembly includes a housing having at least one internal feature, a first and a second handle movable relative to the housing between a spaced-apart position and an approximated position, and an inner actuation assembly disposed within the housing and operably coupled to the first handle and the second handle.
- the inner actuation assembly includes a proximal drive member defining a lumen, a proximal pusher bar slidably disposed within the lumen of the proximal drive member and movable in relation to the proximal drive member, a handle spring assembly, and a linkage assembly.
- the handle spring assembly includes a transverse body portion supported within the at least one internal feature of the housing and a first spring arm and a second spring arm each extending outwardly from opposing lateral sides of the transverse body portion.
- the first spring arm is configured to engage the first handle and the second spring arm is configured to engage the second handle, such that, the first handle and the second handle are biased towards the spaced-apart position.
- the linkage assembly is configured to pivotably couple the first handle and the second handle to the inner actuation assembly.
- the proximal drive member and the proximal pusher bar are configured to move in relative opposing directions.
- the reposable surgical clip applier further includes a shaft assembly releasably engagable with the handle assembly and a clip cartridge assembly releasably engagable within the shaft assembly.
- proximal refers to the end portion of the apparatus or component thereof which is closer to the user and the term “distal” refers to the end portion of the apparatus or component thereof which is further away from the user.
- Surgical clip applier 10 includes a handle assembly 100, a shaft assembly 200 extending distally from handle assembly 100, and a clip cartridge assembly 300 mounted within shaft assembly 200.
- Shaft assembly 200 is removably and selectively engagable with handle assembly 100 and clip cartridge assembly 300 is removably and selectively mountable within shaft assembly 200.
- Handle assembly 100 and shaft assembly 200 may be configured as sterilizable, reusable components, while clip cartridge assembly 300 may be configured as a single-procedure-use component.
- a stack of surgical clips "C" FIG.
- each actuation of handle assembly 100 actuates cooperating drive components of handle assembly 100, shaft assembly 200, and cartridge assembly 300 to fire and form a single surgical clip from the stack of surgical clips "C" ( FIG. 3 ) around a vessel or other tissue to ligate the vessel or other tissue.
- clip cartridge assembly 300 includes a cartridge housing or housing 310, a clip carrier 320, a clip follower 330, a distal pusher 340, a slider 350, a first biasing member 360, a second biasing member 370, a carrier lock 380, and a stack of surgical clips "C.”
- cartridge housing 310 includes an upper housing portion 310a, a lower housing portion 310b, and an internal cavity 312 extending along a length of the cartridge housing 310 between a distal end portion and a proximal end portion thereof.
- Cartridge housing 310 may be formed at least partially from a transparent material, such as, for example, a transparent plastic, to enable visualization into internal cavity 312 thereof.
- Cartridge housing 310 includes a pair of internal grooves 314a, 314b extending longitudinally along at least a portion of the length of the cartridge housing 310, on opposing internal walls 311a, 311b thereof.
- the pair of internal grooves 314a, 314b are configured to retain clip carrier 320 and carrier lock 380 when clip carrier 320 and carrier lock 380 are disposed within internal cavity 312 of cartridge housing 310, as will be detailed below.
- Internal cavity 312 of cartridge housing 310 is also configured to receive at least a portion of clip follower 330, distal pusher 340, slider 350, first biasing member 360, second biasing member 370, and the stack of surgical clips "C" therein.
- upper housing portion 310a of cartridge housing 310 includes a window 316 formed therein and configured to slidably receive a cap portion 352 of slider 350.
- Cartridge housing 310 includes a protrusion 317 extending transversely into proximal window 316 from a side thereof.
- Cap portion 352 of slider 350 defines a more-proximally positioned recess 353a defined on a side thereof and a more-distally positioned recess 353b defined on the same side thereof. More-proximally positioned recess 353a is configured to receive protrusion 317 of cartridge housing 310 to releasably retain slider 350 in a distal position relative to cartridge housing 310.
- protrusion 317 of cartridge housing 310 is dislodged from more-proximally positioned recess 353a of cap portion 352 of slider 350, enabling slider 350 to slide proximally through window 316.
- protrusion 317 is engaged within more-distally positioned recess 353b of cap portion 354 of slider 350 to thereby releasably retain slider 350 in a proximal position relative to cartridge housing 310.
- the proximal and distal positions of slider 350 are described in detail hereinbelow.
- lower housing portion 310b of cartridge housing 310 includes a support base 313 configured to enclose and support at least a portion of distal pusher 340 when distal pusher is disposed within internal cavity 312 of cartridge housing 310 ( FIG. 5 ).
- Support base 313 includes a first or distal bridge portion 313a and a second or proximal bridge portion 313b extending between and coupled to lateral sides of cartridge housing 310.
- the first and second bridge portions 313a, 313b are longitudinally spaced apart and at least a portion of distal pusher 340 is disposed thereon.
- Second bridge portion 313b includes an aperture or slot 313c configured to receive a proximal end portion 372 of second biasing member 370 thus fixing proximal end portion 372 of second biasing member 370 relative to cartridge housing 310, as will be further detailed below.
- lower housing portion 310b of cartridge housing 310 may include more than two bridge portions or may be entirely enclosed.
- clip carrier 320 of clip cartridge assembly 300 includes a floor 324 and a pair of side walls 326a, 326b extending longitudinally along the opposed sides of floor 324 such that clip carrier 320 defines a generally U-shaped configuration.
- Clip carrier 320 includes a pair of engagement flanges 322a, 322b configured to engage the pair of internal grooves 314a, 314b of opposing internal walls 311a, 311b, respectively, of cartridge housing 310.
- the pair engagement flanges 322a, 322b extend laterally from the pair of side walls 326a, 326b, respectively, and are disposed within the pair of internal grooves 314a, 314b of cartridge housing 310 to prevent axial movement of clip carrier 320 relative to cartridge housing 310.
- carrier lock 380 includes a body 382 having a central arm 384a, a pair of side arms 384b, 384c disposed on opposing lateral sides of central arm 384a and outwardly biased therefrom, and a pair of legs 386a, 386b folded below and under a proximal end portion of body 382.
- Each side arm 384b, 384c includes a tang 388a, 388b, respectively, extending outwardly therefrom.
- Internal cavity 312 of cartridge housing 310 is configured to receive carrier lock 380 such that the pair of side arms 384b, 384c are slidably disposed within internal grooves 314a, 314b, respectively, of cartridge housing 310.
- Cartridge housing 310 includes a pair of slots 318a, 318b extending through opposing internal walls 311a, 311b.
- the pair of slots 318a, 318b are positioned and configured to receive the pair of tangs 388a, 388b extending outwardly from the pair of side arms 384b, 384c, respectively, to releasably retain carrier lock 380 within internal cavity 312 of cartridge housing 310.
- Each of the pair of tangs 388a, 388b includes a proximal portion 389a that is substantially parallel relative to a respective proximal portion of the pair of slots 318a, 318b and a distal portion 389b that is angled relative to a respective distal portion of the pair of slots 318a, 318b.
- carrier lock 380 is configured for positioning proximally adjacent a proximal end portion of clip carrier 320 such that central arm 384a of carrier lock 380 is disposed in abutting relation therewith.
- carrier lock 380 is slidably retained within internal cavity 312 via engagement between the pair of tangs 388a, 388b and the pair of slots 318a, 318b, clip carrier 320 is inhibited from moving proximally beyond central arm 384a of carrier lock 380. In this manner, clip carrier 320 is retained within internal cavity 312 of cartridge housing 310.
- clip follower 330 of clip cartridge assembly 300 includes a distal sled 332 slidably disposed within clip carrier 320 proximally of the stack of surgical clips "C.”
- Distal sled 332 of clip follower 330 is configured for positioning proximally adjacent a proximal-most clip "C2" of the stack of surgical clips "C” in abutting relation therewith.
- Distal sled 332 further defines a pair of slots 333 therethrough, as detailed below.
- Clip follower 330 further includes an elongated rod 334 extending proximally from distal sled 332.
- distal pusher 340 of clip cartridge assembly 300 is slidably disposed about an underside of clip carrier 320, opposite clip follower 330.
- Distal pusher 340 includes a pair of pusher flanges 342 at a distal end portion thereof that are configured to urge the distal-most surgical clip "C1" of the stack of surgical clips “C” distally over resilient central tang 328 of clip carrier 320 and distally from clip cartridge assembly 300 into jaws 238 ( FIG. 10 ).
- Distal pusher 340 additionally includes a proximally-facing pusher surface 348 disposed at the proximal end portion thereof.
- Proximally-facing pusher surface 348 may be part of a proximal extension 349 that is monolithically formed with distal pusher 340 and folded below and under the proximal end portion thereof to define proximally-facing pusher surface 348.
- slider 350 of clip cartridge assembly 300 includes a base portion 354 and a cap portion 352 disposed on base portion 354.
- Cap portion 352 is configured for slidable receipt within window 316 of cartridge housing 310 and is releasably engagable therein in either a proximal position or a distal position.
- base portion 354 of slider 350 In the distal position, does not extend proximally beyond the proximal end portion of cartridge housing 310. In the proximal position, base portion 354 extends proximally beyond the proximal end portion of cartridge housing 310.
- movement of slider 350 between the distal and proximal position enables selective locking and unlocking of clip cartridge assembly 300 within shaft assembly 200 ( FIG. 1 ).
- Elongated cut-out 218 is also spaced-apart from open proximal end portion 214 of outer tube 210 such that outer tube defines a tubular proximal segment 219b disposed proximally of elongated cut-out 218.
- Tubular proximal segment 219b includes an elongated recess or slot 219c configured to engage handle assembly 100 ( FIG. 20 ) to selectively couple shaft assembly 200 and handle assembly 100, as detailed below.
- tubular proximal segment 219b may include more than one slot 219c.
- inner drive assembly 240 of shaft assembly 200 includes a distal drive bar 242 and a proximal drive plunger 244.
- Distal drive bar 242 includes a base 243a and a pair of side walls 243b extending longitudinally along opposing sides of base 243a so as to define an inner channel 243c extending longitudinally along distal drive bar 242.
- Proximal drive plunger 244 of inner drive assembly 240 is slidably disposed within lumen 226 of inner bushing 220, when inner bushing 220 is disposed within tubular proximal segment 219b of outer tube 210.
- Proximal drive plunger 244 includes a hub 245 having an open distal end portion 246a, an open proximal end portion 246b, and a hub lumen 247 extending between and communicating with the open distal and proximal end portions, 246a, 246b, respectively.
- proximal pusher bar 148 extends through lumen 141 of body 143a and neck portion 143b of outer drive tube 142 in slidable relation relative thereto, distally from open distal end portion 246a of hub 245.
- slider 350 is urged proximally such that protrusion 317 of cartridge housing 310 is dislodged from more-proximally positioned recess 353a of cap portion 352 of slider 350, slider 350 is slid proximally through window 316, and protrusion 317 is engaged within more-distally positioned recess 353b of cap portion 352 of slider 350 to retain slider 350 in the proximal position.
- handles 130 may be released or returned towards the spaced-apart position ( FIG. 1 ) such that proximal pusher bar 148 is moved distally through lumen 141 of outer drive tube 142 and towards the distal-most position of proximal pusher bar 148.
- proximal pusher bar 148 is moved distally, a distal end portion of proximal pusher bar 148 is urged into proximally-facing pusher surface 348 of distal pusher 340 to thereby urge distal pusher 340 distally.
- Surgical instruments such as the clip applier(s), or components thereof, described herein may also be configured to work with robotic surgical systems and what is commonly referred to as "Telesurgery.”
- Such systems employ various robotic elements to assist the surgeon and allow remote operation (or partial remote operation) of surgical instrumentation.
- Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with a robotic surgical system to assist the surgeon during the course of an operation or treatment.
- Such robotic systems may include remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc.
- the robotic surgical systems may be employed with one or more consoles that are next to the operating theater or located in a remote location.
- one team of surgeons or nurses may prep the patient for surgery and configure the robotic surgical system with one or more of the instruments disclosed herein while another surgeon (or group of surgeons) remotely control the instruments via the robotic surgical system.
- a highly skilled surgeon may perform multiple operations in multiple locations without leaving his/her remote console which can be both economically advantageous and a benefit to the patient or a series of patients.
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- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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Claims (15)
- Wiederverwendbare Anbringvorrichtung (10), für chirurgische Klammern, die Folgendes umfasst:
eine Griffanordnung (100), die Folgendes einschließt:ein Gehäuse (110);wenigstens einen Griff (130), der sich von dem Gehäuse erstreckt und relativ zu dem Gehäuse zwischen einer voneinander beabstandeten Position und einer angenäherten Position beweglich ist; undeine innere Betätigungsanordnung (140), die sich von dem Gehäuse erstreckt und mit dem wenigstens einen Griff wirkgekoppelt ist, wobei die innere Betätigungsanordnung Folgendes einschließt:ein proximales Antriebselement (142), das durch das Gehäuse beweglich ist;eine proximale Schubstange (148), die durch das proximale Antriebselement beweglich ist; undeine Grifffederanordnung (144), die wenigstens einen Federarm (147) aufweist, der den wenigstens einen Griff in Eingriff nimmt, um den wenigstens einen Griff in Richtung der beabstandeten Position vorzuspannen, wobei eine Bewegung des wenigstens einen Griffs relativ zu dem Gehäuse konfiguriert ist, um das proximale Antriebselement und die proximale Schubstange in relativ entgegengesetzte Richtungen zu bewegen;eine Schaftanordnung (200), die mit der Griffanordnung lösbar in Eingriff gebracht werden kann, wobei die Schaftanordnung Folgendes einschließt:ein Außenrohr (210);eine Backenanordnung (230), die an einem distalen Endabschnitt (212) des Außenrohrs gelagert ist; undeine innere Antriebsanordnung (240), die innerhalb des Außenrohrs verschiebbar angeordnet ist und mit der Backenanordnung derart wirkgekoppelt ist, dass eine distale Bewegung der inneren Antriebsanordnung durch das Außenrohr die Backenanordnung betätigt; undeine Klammermagazinanordnung (300), die innerhalb der Schaftanordnung lösbar in Eingriff gebracht werden kann, wobei die Klammermagazinanordnung einen Stapel chirurgischer Klammern ("C") darin hält und einen distalen Schieber (340) einschließt, der mit einer distalsten chirurgischen Klammer des Stapels chirurgischer Klammern derart wirkgekoppelt ist, dass die distale Bewegung des distalen Schiebers die distalste chirurgische Klammer in die Backenanordnung lädt, wenn die Klammermagazinanordnung innerhalb der Schaftanordnung lösbar in Eingriff gebracht ist, wobei, wenn die Schaftanordnung (200) die Griffanordnung (100) lösbar in Eingriff nimmt und die Klammermagazinanordnung (300) innerhalb der Schaftanordnung lösbar in Eingriff genommen wird:das proximale Antriebselement (142) an die innere Antriebsanordnung (240) derart proximal angrenzend positioniert ist, dass die Bewegung des wenigstens einen Griffs in Richtung der angenäherten Position die Backenanordnung betätigt, unddie proximale Schubstange (148) derart proximal angrenzend proximal angrenzend an den distalen Schieber (340) positioniert ist, dass die Bewegung des wenigstens einen Griffs in Richtung der beabstandeten Position die distalste chirurgische Klammer in die Backenanordnung lädt,dadurch gekennzeichnet, dass die Grifffederanordnung (144) einen Querkörperabschnitt (145) einschließt, der innerhalb eines proximalen Endabschnitts des Gehäuses lösbar gehalten wird, wobei der Querkörperabschnitt eine Bohrung (145c) definiert, die konfiguriert ist, um mit dem Außenrohr (210) der Schaftanordnung (200) derart in Kommunikation zu stehen, dass das proximale Antriebselement (142) durch die Bohrung der Grifffederanordnung beweglich ist, um bei Bewegung des wenigstens einen Griffs (130) die innere Antriebsanordnung (240) der Schaftanordnung in Eingriff zu nehmen. - Wiederverwendbare Anbringvorrichtung für chirurgische Klammern nach Anspruch 1, wobei sich der wenigstens eine Federarm (147) der Grifffederanordnung (144) von dem Querkörperabschnitt (145) nach außen erstreckt und einen freien proximalen Endabschnitt (147b) einschließt, wobei der freie proximale Endabschnitt des wenigstens einen Federarms bei Bewegung des wenigstens einen Griffs entlang des wenigstens einen Griffs (130) verschiebbar ist.
- Wiederverwendbare Anbringvorrichtung für chirurgische Klammern nach Anspruch 1 oder 2, wobei das Gehäuse (110) wenigstens ein internes Merkmal einschließt, das eine Schwenkaussparung (117) definiert, die konfiguriert ist, um einen distalen Endabschnitt des wenigstens einen Griffs (130) beweglich aufzunehmen, wobei die Schwenkaussparung und der wenigstens eine Griff bemessen und konfiguriert sind, um zusammenzuarbeiten, um die Bewegung des wenigstens einen Griffs über eine vorgegebene angenäherte Position hinaus und über eine vorgegebene voneinander beabstandete Position hinaus zu begrenzen.
- Wiederverwendbare Anbringvorrichtung für chirurgische Klammern nach einem der vorhergehenden Ansprüche, wobei die Bewegung des wenigstens einen Griffs (130) in Richtung der angenäherten Position das proximale Antriebselement (142) distal um die proximale Schubstange (148) bewegt, und die proximale Schubstange (148) proximal um und durch das proximale Antriebselement (142) bewegt, und wobei die Bewegung des wenigstens einen Griffs (130) in Richtung der voneinander beabstandeten Position das proximale Antriebselement (142) proximal um die proximale Schubstange (148) bewegt und die proximale Schubstange (148) distal um und durch das proximale Antriebselement (142) bewegt.
- Wiederverwendbare Anbringvorrichtung für chirurgische Klammern nach einem der vorhergehenden Ansprüche, wobei die Klammermagazinanordnung (300) ferner ein Vorspannelement (370) einschließt, das konfiguriert ist, um den distalen Schieber (340) proximal vorzuspannen.
- Wiederverwendbare Anbringvorrichtung für chirurgische Klammern nach Anspruch 5, wobei die Klammermagazinanordnung (300) ferner ein Magazingehäuse (310) einschließt, das eine Lagerungsbasis (313) aufweist, die konfiguriert ist, um wenigstens einen Abschnitt des distalen Schiebers (340) zu lagern, wobei die Lagerungsbasis einen distalen Brückenabschnitt (313a) und einen proximalen Brückenabschnitt (313b) einschließt, wobei das Vorspannelement (370) der Klammermagazinanordnung mit dem distalen Schieber (340) und dem proximalen Brückenabschnitt (313a) wirkgekoppelt ist, um den distalen Schieber proximal vorzuspannen.
- Wiederverwendbare Anbringvorrichtung für chirurgische Klammern nach Anspruch 6, wobei die Klammermagazinanordnung (300) ferner einen Klammerträger (320) einschließt, der ein Paar Eingriffsflansche (322a, 322b) einschließt, und wobei das Magazingehäuse (310) ein Paar innerer Nuten (314a, 314b) einschließt, die sich in Längsrichtung entlang wenigstens eines Abschnitts einer Länge des Magazingehäuses erstrecken, wobei das Paar innerer Nuten konfiguriert ist, um das Paar Eingriffsflansche seitlich aufzunehmen, beziehungsweise um eine axiale Bewegung des Klammerträgers relativ zu dem Magazingehäuse zu verhindern; vorzugsweise wobei die Klammermagazinanordnung (300) ferner eine Trägerverriegelung (380) einschließt, die proximal an einen proximalen Endabschnitt des Klammerträgers (320) angrenzend angeordnet ist, wobei die Trägerverriegelung ein Paar gegenüberliegender Arme (384a, 384c) einschließt, die konfiguriert sind, um ein Paar gegenüberliegender Innenwände des Magazingehäuses (310) vorspannend in Eingriff zu nehmen, wobei die Trägerverriegelung konfiguriert ist, um eine proximale Bewegung des Klammerträgers relativ zu dem Magazingehäuse über die Trägerverriegelung hinaus zu verhindern.
- Wiederverwendbare Anbringvorrichtung für chirurgische Klammern nach einem der vorhergehenden Ansprüche, wobei das Gehäuse (110) der Griffanordnung (100) einen offenen distalen Endabschnitt (126a) einschließt, der einen zentralen Durchgang (118) und einen Vorsprung (128) definiert, der sich nach innen in den zentralen Durchgang erstreckt, und wobei die Schaftanordnung (200) ein röhrenförmiges proximales Segment (219b) einschließt, das einen Schlitz (219c) definiert, der konfiguriert ist, um den Vorsprung beim Einführen des röhrenförmigen proximalen Segments in den offenen distalen Endabschnitt aufzunehmen, um die Schaftanordnung mit der Griffanordnung lösbar in Eingriff zu bringen.
- Wiederverwendbare Anbringvorrichtung für chirurgische Klammern nach Anspruch 8, wobei die Schaftanordnung (200) ferner eine innere Buchse (220) einschließt, die zwischen dem röhrenförmigen proximalen Segment (219b) und der inneren Antriebsanordnung (240) angeordnet ist, wobei die innere Buchse einen Schlitz (228) einschließt, der konfiguriert ist, um axial mit dem Schlitz (219c) des röhrenförmigen proximalen Segments ausgerichtet zu sein, wenn die innere Buchse darin angeordnet ist, derart, dass der Vorsprung (128), der sich von dem Gehäuse (110) nach innen erstreckt, innerhalb des Schlitzes des röhrenförmigen proximalen Segments und des Schlitzes der inneren Buchse aufgenommen ist.
- Wiederverwendbare Anbringvorrichtung für chirurgische Klammern nach einem der vorhergehenden Ansprüche, wobei die Griffanordnung (100) ein Paar Griffe (130) einschließt, die mit dem Gehäuse (110) schwenkbar gekoppelt sind und sich von gegenüberliegenden Seiten davon erstrecken.
- Wiederverwendbare Anbringvorrichtung für chirurgische Klammern nach Anspruch 10, wobei die Grifffederanordnung (144) ein Paar Federarme (147) einschließt, die sich von gegenüberliegenden Seiten des Querkörperabschnitts (145) nach außen erstrecken, wobei jeder Federarm des Paars Federarme konfiguriert ist, um einen jeweiligen Griff (130) des Paars Griffe in Eingriff zu nehmen, um das Paar Griffe in Richtung der beabstandeten Position vorzuspannen.
- Wiederverwendbare Anbringvorrichtung für chirurgische Klammern nach Anspruch 11, wobei das Paar Federarme (147) jeweils einen freien proximalen Endabschnitt (147b) einschließt, der konfiguriert ist, um entlang des jeweiligen Griffs (130) des Paars Griffe bei Bewegung des Paars Griffe zu gleiten.
- Wiederverwendbare Anbringvorrichtung für chirurgische Klammern nach einem der Ansprüche 10 bis 12, wobei die Griffanordnung (100) ferner eine Verbindungsanordnung (160) einschließt, die konfiguriert ist, um das Paar Griffe (130) mit der inneren Betätigungsanordnung (140) schwenkbar zu koppeln, wobei die Verbindungsanordnung einen ersten Verbindungsarm (162), der konfiguriert ist, um einen ersten Griff des Paars Griffe (130) mit dem proximale Antriebselement (142) wirkzukoppeln, und einen zweiten Verbindungsarm (164) aufweist, der konfiguriert ist, um einen zweiten Griff des Paars Griffe mit der proximalen Schubstange (148) wirkzukoppeln, wobei bei Bewegung des Paars Griffe in Richtung der angenäherten Position, der erste Verbindungsarm (162) konfiguriert ist, um das proximale Antriebselement (142) distal zu bewegen, und der zweite Verbindungsarm (164) konfiguriert ist, um die proximalen Schubstange (148) proximal zu bewegen, und wobei bei Bewegung des Paars Griffe (130) in Richtung der voneinander beabstandeten Position der erste Verbindungsarm (162) konfiguriert ist, um das proximale Antriebselement (142) proximal zu bewegen, und der zweite Verbindungsarm (164) konfiguriert ist, um die proximale Schubstange (148) distal zu bewegen.
- Wiederverwendbare Anbringvorrichtung für chirurgische Klammern nach Anspruch 13, wobei die Verbindungsanordnung (160) konfiguriert ist, um das proximale Antriebselement (142) gleichzeitig mit der proximalen Schubstange (148) bei Bewegung des Paars Griffe (130) zu bewegen; und/oder wobei die Verbindungsanordnung (160) ferner einen dritten Verbindungsarm (166), der konfiguriert ist, um den zweiten Griff des Paars Griffe (130) mit dem proximalen Antriebselement (142) wirkzukoppeln und einen vierten Verbindungsarm (168) einschließt, der konfiguriert ist, um den ersten Griff des Paars Griffe mit der proximalen Schubstange (148) wirkzukoppeln.
- Wiederverwendbare Anbringvorrichtung für chirurgische Klammern nach Anspruch 14, wobei die proximale Schubstange (148) konfiguriert ist, um sich zwischen dem ersten Verbindungsarm (162) und dem dritten Verbindungsarm (166) zu bewegen, während sich die proximale Schubstange (148) durch das proximale Antriebselement (142) bewegt.
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2018
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AU2018260903A1 (en) | 2019-06-27 |
EP3498196A2 (de) | 2019-06-19 |
JP2019103798A (ja) | 2019-06-27 |
CN109907793A (zh) | 2019-06-21 |
US10849630B2 (en) | 2020-12-01 |
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